Vegetative state recovery

[paigetheoracle]

An article appeared in the British press last week about people in comatose states being able to respond as though conscious, even though physically unresponsive. Another article has now appeared suggesting that brain damaged patients respond to sleeping pills in a way that returns them to mobility and allows them to communicate too.

This reminds me of the Encephilitis patients mentioned in the film and the book it was based on by Oliver Sacks, 'Awakenings', who retuned to normal after treatment by revolutionary treatment before sadly returning to a vegetative state.

It also made me think of Catatonia sufferers and the use of muscle relaxants to relieve the perpetual, convulsive spasm or 'stress reaction' they go into - hence sleeping pills being used on the South African patients with such success (living rigor mortis state).

It also reminded me of the Victorians fear of being buried alive (air pipes to the surface/ pulleys and bells to signal with), and how there might well be some justification for this belief, given this new evidence (Edgar Allen Poe theme). It also ties in with people being declared dead and then coming round in the morgue (see Fortean Times), plus recent cases of people reporting being fully conscious during operations (anaesthesia acting like curare - paralysing victim but not necessarily killing them).

All of these cases seem to indicate that our methods of deciding who is dead and who is not are nowhere as foolproof as we thought - likewise that paralysis and brain damage means A) patients will never recover and B) that coma means brain dead. On top of this perhaps what we assume is vegetative, is in fact a kind of tension, rather than irreversible brain damage and drug induced relaxation techniques 'might' work across the spectrum on those seemingly paralysed or brain damaged, through illness or injury.

Exciting times! Thoughts on this from the medical profession?

[Chacmool]

Fascinating indeed!

I have specified to my family that I wouldn't want to be kept alive artificially, if the situation ever arose. Also, if it were legal at that time, I would prefer euthanasia if I were suffering or in a vegetative state. However, taking into consideration the latest information, I don't think their final decision would be that simple.

[CraigD]

This tread examines a very important subject which many readers may need to understand well at some point in their lives.

Originally Posted by paigetheoracle

All of these cases seem to indicate that our methods of deciding who is dead and who is not are nowhere as foolproof as we thought - likewise that paralysis and brain damage means A) patients will never recover and B) that coma means brain dead. On top of this perhaps what we assume is vegetative, is in fact a kind of tension, rather than irreversible brain damage and drug induced relaxation techniques 'might' work across the spectrum on those seemingly paralysed or brain damaged, through illness or injury.

The modern definition of death – ”brain death” - is, I think, very reliable, so much so that no person has incorrectly been declared dead by a physician in a modern hospital in over a decade.

I think what Paige, and the articles and films he mentions, are emphasizing, is the much more difficult determination of whether a person in a coma or persistent vegetative state, will recover to have some sort of normal life, or die without showing signs of consciousness, sometimes after years of life maintaining care that can be financially and emotionally hurtful to their family and friends. In this area, medical technology that allows successful long-term life maintenance, necessitates the difficult ethical decision to continue of stop such treatment, while sometimes providing only an uncertain estimate of the patient’s likelihood of eventual recovery.

A couple of details

• The patients in Awakenings suffered from catatonia, a condition less medically severe that PVS, and meeting none of the criteria for brain death. Such people typically show occasional awareness, have enough voluntary movement that they don’t develop ”bed sore” ulcers, and can usually be fed orally, without an NG tube. In none but the most radically euthanasia-promoting societies would anyone suggest that these people could be denied care to the extent that they died, or euthanized.
• Determining likelihood of recovery is not difficult in all cases of coma/PVS. For example, the recent (2005) case of Terry Schiavo is one in which no competent, ethical diagnosis of her condition was uncertain in determining that she could not recover. Imaging (CT scan), confirmed by her 2005 autopsy, revealed gross loss of brain tissue – about 50% of its normal mass. There is no theoretical or empirical evidence that a brain so damaged can heal.
• ”Mild” coma is not uncommon, and the majority of patients recover from it fully. By modern definitions such as the GCS, normal conditions such as sleep and conditions such as general anesthesia, with very high (99.9995%) expectation of full recovery, qualify as slight coma.

[paigetheoracle]

Very good point CraigD and one I meant to mention. The only reason for keeping anyone alive in that state is that is a chance in the future that they can return to normality and become as fully functioning as possible. If this isn't possible then why keep the shell alive, even if there is signs of consciousness? (Paralysed for ever but able to respond - a living hell without input, except TV - computer connection, might be more viable though: Perhaps there is an unconscious link within science, thinking of future man becoming robotic and brain transplants but this is the only sensible thought I can discover for keeping someone on a life support machine indefinitely and even then it's a bit morally dubious as this isn't just round the corner, except in science fiction (Dr Who and The Cybermen)